Asthma

Asthma overview:

Asthma is an inflammatory disease of the lungs, marked by “over-reactive” lungs, that may begin at any age.  It is a complex disease that it varies tremendously from one person to the next.  It may be intermittent or persistent, and can range from mild to severe.  Common symptoms include feeling chest tightness, shortness of breath, wheezing, and coughing.  The cough is often worse at night.

Asthma triggers:

About 80% of asthmatic patients have allergic triggers, thus it is critical to get allergy tested.  Indeed, the National Heart, Lung, and Blood Institute Asthma guidelines recommend that all asthmatics have an allergy evaluation to get identify their allergic triggers.  Other frequently seen triggers include ordinary infections (like the common cold or the flu), exercise, chemical irritants and cigarette smoke, and abrupt weather changes, especially cold weather.  Allergies and infections often cause inflammation (swelling, irritation, and excess mucus) of the airways, leading to increased spasm of the airway muscles and asthma symptoms.

Lung function testing:

Pulmonary function testing (also called spirometry) is essential in the diagnosis and ongoing management of asthma.  This test will help your asthma specialist to know how well your lungs are doing at baseline and will help show us how your lungs are responding to medication.

Asthma medications:

All asthmatics need to have on hand, a quick relief, short-acting bronchodilator medication to relieve airway spasm.  These are often used on an as needed basis, or prior to exercise.  The most widely used medicine in this class is albuterol.

When this is not enough, anti-inflammatory medications (inhaled corticosteroids) are required on a daily basis to control asthma by decreasing the underlying airway inflammation, thus reducing the tendency for airway spasm and symptoms.

Sometimes a short course of oral steroids is needed to relieve a bad asthma flare-up, however should be limited by their side effects.  Your doctor will determine if you need these.

Lastly, there has been a tremendous surge in asthma “biologics.”  Biologics are antibodies that target specific aspects of the immune system inflammatory cascade.  We are just on the horizon of new asthma treatments, based on a much deeper understanding of asthma subtypes.  The most widely used of this class of medications is omalizumab.